fibrocystic disease of the pancreas

fibrocystic

[fi″bro-sis´tik]

characterized by an overgrowth of fibrous tissue and the development of cystic spaces, especially in a gland.

fibrocystic disease of breast a disorder characterized by single or multiple benign tumors in the breast; it is the most common disorder of premenopausal women between the ages of 30 and 55, has a familial tendency, and usually abates after menopause. It is due to abnormal hyperplasia of the ductal epithelium and dilatation of the ducts of the mammary gland. Called also chronic cystic mastitis, cystic disease of the breast, and Schimmelbusch's disease.

The tumors of true fibrocystic breast disease can be fluid-filled cysts that arise from glandular elements (blue dome cysts), or solid fibrous growths containing connective tissue elements (fibroadenomas). It was once believed that women with this disorder had a two to three times greater than average risk of developing breast cancer; however, recent studies have shown the risk to be only about 1.6 times greater. Since this disorder does predispose a woman to a breast malignancy, it is recommended that it be carefully monitored by periodic examinations, radiologic studies, and biopsies to identify malignant changes in their earliest stages. Baseline mammography is done for the young patient, and routine regular mammograms are done for the older patient.

Since many cases subside on their own after menopause, it is believed that the cyclic appearance of symptoms is linked to estrogen levels.

Symptoms. The most outstanding symptom of fibrocystic disease of the breast is the presence of one or more lumps in the breast. There also is a feeling of breast fullness and tenderness that is more noticeable each month during the premenstrual period. The presence of cysts and lumps in the breast can produce anxiety for the patient and make self-examination more difficult. Additionally, the frequent examinations needed to rule out malignant changes add to physical discomfort and psychologic stress.

Treatment and Patient Care. Medical treatment usually consists of hormonal therapy with synthetic androgen; a commonly used agent is danazol. Synthetic androgens depress ovarian functions, causing a lessening of symptoms. However, common side effects such as menstrual irregularities, weight gain, edema, and acne do occur. Hormonal therapy is usually reserved for those women who cannot find relief through more conservative therapy.

Among the self-help methods that have been successful are reduction of stressors in their lives and dietary restriction of all forms of methylxanthines, particularly caffeine. If the patient is able to eliminate her intake of caffeine, it usually takes at least two months for the effects of the restriction to become apparent. Other measures that have had varying degrees of success include limiting salt and taking a mild diuretic during the week before menstruation begins, applying warm compresses to the breast, wearing a brassiere that gives good support, and taking a mild nonprescription analgesic for discomfort.

Patient education includes instruction in self-examination of the breast with emphasis on the importance of doing this each month. Once the woman becomes accustomed to the location and size of her breast lumps she is better able to detect any change that might occur. The ideal time for breast self-examination is five to seven days after menstruation when swelling and tenderness are usually at a minimum.

cys·tic fi·bro·sis

, cystic fibrosis of the pancreas [MIM*219700]

a congenital metabolic disorder in which secretions of exocrine glands are abnormal; excessively viscid mucus causes obstruction of passageways (including pancreatic and bile ducts, intestines, and bronchi), and the sodium and chloride content of sweat is increased throughout the patient's life; symptoms usually appear in childhood and include meconium ileus, poor growth despite good appetite, malabsorption and foul bulky stools, chronic bronchitis with cough, recurrent pneumonia, bronchiectasis, emphysema, clubbing of the fingers, and salt depletion in hot weather. Detailed genetic mapping and molecular biology have been accomplished by the methods of reverse genetics; autosomal recessive inheritance, caused by mutation in the cystic fibrosis conductance regulator gene (CFTR) on chromosome 7q.

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